Provider Demographics
NPI:1013529049
Name:LICKUS CRAVENS, ANNE LUCIA (PHD, AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LUCIA
Last Name:LICKUS CRAVENS
Suffix:
Gender:F
Credentials:PHD, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:SUMMERLAND
Mailing Address - State:CA
Mailing Address - Zip Code:93067-1432
Mailing Address - Country:US
Mailing Address - Phone:805-570-7322
Mailing Address - Fax:
Practice Address - Street 1:324 E CARRILLO ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-7439
Practice Address - Country:US
Practice Address - Phone:805-963-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC6502101YP2500X
CAAMFT113772106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional